Surgical Approaches to the TMJ

The Preauricular approach

 

¨ The most common approach via a vertical incision 3cm in length in front of the ear, extending to just below the tragus

¨ The dissection remains above the main trunk of the facial nerve

¨ The joint capsule is exposed from  posteriosuperior aspect

¨ The preauricular approach gives good access to the joint itself, but access to the condylar neck is poor.

 

 

The Submandibular Approach

 

¨ 5cm skin incision 2 finger breadths below the angle of the mandible, in a skin crease

¨ Dissection is to the deep investing layer of fascia to preserve the marginal mandibular branch (vii) and continued upwards to the condylar neck

¨ Access is still not good

 

 

Other approaches have been described to overcome these problems

These may improve the visible scarring, but do relatively little for access and increase the potential for ear damage

 

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Disc Displacement disorders